title: Detection of high-burden coronary artery disease by exercise-induced changes of the E/E' ratio.
abstract: To investigate whether exercise-induced changes of the E/E' average ratio can detect high-burden coronary artery disease (CAD) in patients with chest pain and normal left ventricular (LV) systolic function. The study population consisted of 359 patients admitted for chest pain (59.8 ± 9.8 years, 75% male). Patients underwent exercise echocardiography, scintigraphy and coronary angiography. The average of the lateral and septal ratios of early diastolic transmitral velocity to early diastolic tissue velocity (E/E') at baseline and immediately after exercise was calculated. Exercise induced wall motion abnormalities were also calculated. Coronary angiography showed flow limiting CAD in 238 patients (66%). The exercise-induced changes of E/E' average ratio had a sensitivity of 87.3% and a specificity of 75.2% for detection of flow limiting CAD, whereas myocardial scintigraphy showed 79.2% sensitivity and 80.1% specificity and exercise induced wall motion abnormalities had a sensitivity of 74.3% and a specificity of 66.9%. Likelihood ratio chi square showed an incremental value of the exercise-induced changes of E/E' average ratio over regional perfusion technique (from 121.37 to 194.15, P < 0.001) and over wall motion abnormalities (from 57.03 to 146.50, P < 0.001). The exercise-induced change of the E/E' average ratio detects flow limiting CAD in patients with chest pain and normal LV systolic function showing an incremental value over regional perfusion technique and wall motion abnormalities.
authors.affiliation: Second University Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari, 12462 Athens, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Tsougos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Paraskevaidis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dagres
authors.forename: Christos
authors.initials: C
authors.lastname: Varounis
authors.forename: Fotios
authors.initials: F
authors.lastname: Panou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karatzas
authors.forename: Xenia
authors.initials: X
authors.lastname: Trapali
authors.forename: Efstathios
authors.initials: E
authors.lastname: Iliodromitis
authors.forename: Dimitrios T
authors.initials: DT
authors.lastname: Kremastinos
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003326:Coronary Circulation; D003971:Diastole; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006115:Greece; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left